肩袖修复或重建后 16 年后，疼痛缓解、活动度和功能可能不再持续。
Pain relief, motion, and function after rotator cuff repair or reconstruction may not persist after 16 years.
机构信息
Department of Orthopedics, ORTON Orthopaedic Hospital, Tenholantie 10, 00280, Helsinki, Finland.
出版信息
Clin Orthop Relat Res. 2010 Oct;468(10):2678-89. doi: 10.1007/s11999-010-1403-8. Epub 2010 May 29.
BACKGROUND
Short- to medium-term rotator cuff repair reportedly relieves pain in 82% to 97% of patients and provides normal or almost normal shoulder function in 82% to 92%. However, it is unknown whether pain relief and function persist long term.
QUESTIONS/PURPOSES: We asked whether, after rotator cuff repair or reconstruction, pain relief, ROM, shoulder strength, and function remained over the long term.
PATIENTS AND METHODS
We retrospectively reviewed 75 patients who underwent rotator cuff repair between 1980 and 1989. There were 55 men and 20 women. Their mean age at surgery was 52 years. The minimum followup was 16 years (mean, 20 years; range 16-25 years).
RESULTS
Twenty-eight of the 75 patients (37%) had persistent relief of pain lasting for 20 years. In the remaining 47 patients, alleviation of pain lasted, on average, 14 years (range, 0-24 years). Mean flexion and abduction strength increased postoperatively but during long-term followup decreased to less than preoperative levels. External rotation also decreased. At the last followup, the Constant-Murley score averaged 66 (range, 10-98) in men and 60 (range, 29-89) in women. In the Simple Shoulder Test questionnaire, the mean number of yes answers was eight of 12. Of the 75 patients, 32 (43%) reported impairment in activities of daily living owing to an index shoulder complaint. Severe degenerative changes of the glenohumeral joint were evident in 14 patients (19%).
CONCLUSIONS
The early high functional scores after primary rotator cuff repair or reconstruction of the types we performed in the 1980s did not persist. The function achieved postoperatively was lost, as ROM and strength decreased to less than preoperative values. However, alleviation of pain was long-standing in most patients. Based on our data, we should warn patients to expect less than permanent relief with those repairs. We cannot say whether the same will apply to currently performed types of repairs.
LEVEL OF EVIDENCE
Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
背景
据报道，肩袖短中期修复可缓解 82%至 97%患者的疼痛，并提供 82%至 92%的正常或近乎正常的肩部功能。然而，尚不清楚疼痛缓解和功能是否长期持续存在。
问题/目的：我们想知道在肩袖修复或重建后，疼痛缓解、ROM、肩部力量和功能是否能长期保持。
患者和方法
我们回顾性分析了 1980 年至 1989 年间接受肩袖修复的 75 例患者。其中男性 55 例，女性 20 例。手术时的平均年龄为 52 岁。最小随访时间为 16 年（平均 20 年；范围 16-25 年）。
结果
75 例患者中有 28 例（37%）疼痛持续缓解 20 年。在其余 47 例患者中，疼痛缓解平均持续 14 年（范围 0-24 年）。术后屈伸和外展力量增加，但在长期随访中降至术前水平以下。外旋也减少。末次随访时，男性 Constant-Murley 评分平均为 66（范围 10-98），女性为 60（范围 29-89）。在简单肩部测试问卷中，12 个问题中有 8 个答案为“是”。75 例患者中，32 例（43%）因肩部疼痛导致日常生活活动受损。14 例（19%）患者出现严重的盂肱关节退行性改变。
结论
我们在 20 世纪 80 年代进行的初次肩袖修复或重建的早期高功能评分并没有持续。术后获得的功能丧失，ROM 和力量下降至术前以下。然而，大多数患者的疼痛缓解是长期的。根据我们的数据，我们应该警告患者，这些修复不能永久性缓解疼痛。我们不能说目前进行的修复类型是否会有同样的效果。
证据水平
IV 级，治疗性研究。请参阅作者指南，以获取完整的证据水平描述。
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